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Background: The labor supply of nurses, as one of the main healthcare workers, is an important issue in health human resources planning in all health systems. Finding the factors affecting it, could help policymakers to solve the shortage of nursing work supply. The present study aimed to investigating the quantity and factors affecting the nurses' labor supply in Iran. Method: In this cross-sectional study, a sample of 598 nurses working in public hospitals of Shiraz (Iran) were selected via proportionate stratified random sampling method. The required data was collected using a structured questionnaire which asked working hours and other related factors. To analyze the data, descriptive statistics, univariate analysis and multivariate linear regression were performed using STATA 15. The multivariate labor supply model was estimated separately for married and single nurses. Results: The average weekly working hours of nurses was 54.65 h in all medical centers and 50.28 h in the main hospital. The regression results showed that the labor supply of nurses with work experience (β = − 0.368, P = 0.014), satisfaction with work shift arrangement (β = − 2.473, P = 0.001), income between 60-89 million rial (β = − 14.046, P = 0.002), income between 90-119 million rial(β = − 12.073, P = 0.012), and working in the emergency department (β = − 5.043, P = 0.017) had negative and significant relationship; But there was a positive and significant relationship with satisfaction of the work environment (β = 1.86, P = 0.011), workload at work (β = 1.951, P = 0.023) and employment status (contractual employees) (β = 4.704, P = 0.004). Conclusion: The labor supply function of nurses is affected by demographic, economic and non-economic factors. The most contributing factors were related to non-economic variables. It seems that the non-financial cost and benefits related to the job as well as internal factors have more important role on the nurses' labor supply. [ABSTRACT FROM AUTHOR]

Background: Data on the epidemiology of inflammatory bowel disease (IBD) in the Middle East are scarce. We aimed to describe the clinical phenotype, disease course, and medication usage of IBD cases from Iran in the Middle East. Methods: We conducted a cross-sectional study of registered IBD patients in the Iranian Registry of Crohn's and Colitis (IRCC) from 2017 until 2022. We collected information on demographic characteristics, past medical history, family history, disease extent and location, extra-intestinal manifestations, IBD medications, and activity using the IBD-control-8 questionnaire and the Manitoba IBD index, admissions history, history of colon cancer, and IBD-related surgeries. Results: In total, 9746 patients with ulcerative colitis (UC) (n = 7793), and Crohn's disease (CD) (n = 1953) were reported. The UC to CD ratio was 3.99. The median age at diagnosis was 29.2 (IQR: 22.6,37.6) and 27.6 (IQR: 20.6,37.6) for patients with UC and CD, respectively. The male-to-female ratio was 1.28 in CD patients. A positive family history was observed in 17.9% of UC patients. The majority of UC patients had pancolitis (47%). Ileocolonic involvement was the most common type of involvement in CD patients (43.7%), and the prevalence of structuring behavior was 4.6%. A prevalence of 0.3% was observed for colorectal cancer among patients with UC. Moreover,15.2% of UC patients and 38.4% of CD patients had been treated with anti-tumor necrosis factor (anti-TNF). Conclusion: In this national registry-based study, there are significant differences in some clinical phenotypes such as the prevalence of extra-intestinal manifestations and treatment strategies such as biological use in different geographical locations. [ABSTRACT FROM AUTHOR]

The aim of this study is to investigate death anxiety (DA) and related factors among critical care nurses. Using a cross-sectional research design, 325 critical care nurses in eight hospitals in Iran enrolled in the study. Multiple logistic regression analysis showed that deputy head nurse (OR = 18.299; CI: 1.764–189.817; p =.015), shift morning fixed (OR = 8.061; CI: 1.503–43.243; p =.015), surviving parents (OR = 3.281; CI: 1.072–10.037; p =.037), number of children (OR = 1.866; CI: 1.157–3.010; p =.011), years of working experience (OR = 1.143; CI: 1.048–1.246; p =.003), number of end-of-life patient care in the last 3 months (OR =.900; CI:.828–0.977; p =.012), age (OR =.809; CI:.732–.893; p <.001), CCU nurses (OR =.250; CI:.100–.628; p =.003), and mild stressful life events (SLEs) (OR =.167; CI:.046–.611; p =.007) were significantly related to high DA. Therefore, nurse managers and policymakers should pay special attention to these related factors in developing programs to maintain and promote the health of critical care nurses to improve the quality of nursing care. [ABSTRACT FROM AUTHOR]

Background. By utilizing the nursing care process, healthcare professionals can implement nursing knowledge effectively and efficiently, ultimately leading to a significant improvement in the quality of care provided. Objective. This study aimed to assess writing nursing care plan competence among Ardabil nursing students in northwestern Iran. Methods. The study involved 248 nursing students from the second to eighth semesters in three nursing and midwifery schools located in the Ardabil province of northern Iran. The data were collected using a simple random sampling method and included a demographic questionnaire along with a survey questionnaire on nursing care plan writing skills. This was conducted between May and June 2023. Descriptive statistics, Pearson correlation, t-test, ANOVA, and multiple linear regression analyses were conducted for data analysis. Results. The mean score (SD) for writing a nursing care plan in a student survey was 3.35 (0.57) on a scale of 1 to 5. The survey's weighted mean score for each dimension is as follows: data gathering (D) = 3.40 (0.73), identification of client's problems (P) = 3.40 (0.73), sustainable goals (G) = 3.31 (0.77), appropriateness of intervention (I) = 3.30 (0.67), and recognizing outcomes (O) = 3.37 (0.69). This indicates that the students performed well overall. However, the lowest score was in the appropriateness of interventions dimension. Multiple linear regression analysis revealed that four variables, mean score of grade point average (GPA), age, academic term, and time spent studying (hours per day), were significant predictors of the student survey's scores on writing nursing care plans. These variables could predict 61% of the total variance. Implication for Nursing Management. Nursing school administrators can establish programs to improve education and practice in nursing care plan development based on this study. They can use these findings to enhance nursing education and practice for students, which will ultimately lead to better nursing care plans. Administrators should ensure that students have the necessary skills for writing efficient care plans and provide training courses to improve their writing and critical thinking skills. Policies can be implemented to encourage students to increase their study hours and maintain quality care programs. Conclusion. Nursing students are skilled in creating well-written nursing care plans that follow the nursing process. The quality of these plans improves with higher GPAs and longer study hours. To enhance nursing care plans, nursing education should focus on developing skills and allocating sufficient time for studying and practicing. Collaborating with faculty and administrators, as well as using reliable resources, can also help improve the quality of care plans. [ABSTRACT FROM AUTHOR]

BACKGROUND: Healthcare organizations are among high-risk organizations due to the nature of their work as well as structural, physical and technological complexities. Accordingly, it is important to use risk management and control programs in all departments of these organizations. OBJECTIVE: The present study was conducted for the first time to evaluate the risk management status of the operating room and laboratory departments of Hamadan hospitals in 2022. METHODS: In this descriptive-observational cross-sectional study, laboratory and operating room departments were selected as the research environment. To conduct this research, a valid and reliable questionnaire was used to collect data, and the data were analyzed using SPSS 22 statistical software. RESULTS: The findings of the present study showed that the overall mean score of risk management status for the laboratory and operating room departments was 2.66 ± 0.15 and 2.89 ± 0.13, respectively. Furthermore, there was no statistically significant difference in the mean scores of the research components based on work experience, education level, and gender. CONCLUSION: It is suggested that the laboratory and operating room departments should focus more on adopting policies and solutions to improve the position of risk management, training and budget allocation for risk management. [ABSTRACT FROM AUTHOR]

Foot-and-mouth disease (FMD) is a highly contagious animal disease caused by a ribonucleic acid (RNA) virus, with significant economic costs and uneven distribution across Asia, Africa, and South America. While spatial analysis and modeling of FMD are still in their early stages, this research aimed to identify socio-environmental determinants of FMD incidence in Iran at the provincial level by studying 135 outbreaks reported between March 21, 2017, and March 21, 2018. We obtained 46 potential socio-environmental determinants and selected four variables, including percentage of population, precipitation in January, percentage of sheep, and percentage of goats, to be used in spatial regression models to estimate variation in spatial heterogeneity. In our analysis, we employed global models, namely ordinary least squares (OLS), spatial error model (SEM), and spatial lag model (SLM), as well as local models, including geographically weighted regression (GWR) and multiscale geographically weighted regression (MGWR). The MGWR model yielded the highest adjusted R 2 of 90%, outperforming the other local and global models. Using local models to map the effects of environmental determinants (such as the percentage of sheep and precipitation) on the spatial variability of FMD incidence provides decision-makers with helpful information for targeted interventions. Our findings advocate for multiscale and multidisciplinary policies to reduce FMD incidence. [ABSTRACT FROM AUTHOR]

Background and Aim: Urinary tract infections (UTIs) pose a significant global health threat, primarily attributed to bacteria producing extended-spectrum beta-lactamases (ESBLs), with limited treatment options available. The specific genotypes of ESBL-producing strains remain largely unexplored in Guilan (northern Iran). Hence, the objective of this study was to determine the prevalence of ESBL-producing extra-intestinal pathogenic Escherichia coli (ExPEC) among hospitalized patients in this area. Materials and Methods: In this descriptive cross-sectional study, 269 isolates were examined phenotypically for ESBL production. All ESBLs producing isolates were screened for the presence of virulence and housekeeping genes by polymerase chain reaction (PCR) using specific primers. The antimicrobial susceptibility patterns were determined using the disk diffusion method according to the CLSI recommendation. Results: Out of the 269 E. coli isolates, 107 cases (39.8%) were identified as producers of ESBLs. Antibiotic susceptibility testing conducted on the ESBL-producing isolates revealed the highest levels of resistance to cefotaxime, ampicillin, amoxicillin-clavulanate, cephalothin, cefixime, and ceftriaxone (100.0%). Nalidixic acid exhibited a resistance rate of 91.6%, followed by ceftazidime at 84.1%. On the other hand, the isolates showed the highest susceptibility to imipenem (94.4%), followed by nitrofurantoin (87.9%) and gentamicin (63.9%). Conclusion: The frequency of ESBL-producing ExPEC isolated from UTIs is concerning in Guilan. The most suitable antibiotic with the lowest risk of resistance for the patient can be prescribed using the updated susceptibility and resistance patterns of the bacteria. [ABSTRACT FROM AUTHOR]

Introduction: Drug-drug interactions (DDIs) can reduce therapeutic efficacy and increase the duration and cost of hospitalization so that patients are sometimes exposed to significant complications and even death. Patients in the intensive care unit (ICU) are at higher risk of DDIs for a variety of reasons, including impaired absorption, decreased metabolism, and renal failure. The main objective of this study was to evaluate frequency, clinical ranking and risk factors of potential DDIs in the ICUs of 3 teaching hospitals in Ardabil. Methods : In this descriptive-analytical cross-sectional study, drug prescriptions 355 patients admitted to the ICUs were studied. Patient information including age, sex, diagnosis, number of prescribers, number of drugs, length of stay, and status of patients' discharge (recovery or death) were recorded and checked using the online software up to date and the book Drug Interaction Facts. Finally, the data were statistically analyzed using the SPSS software. Results : The number of patients studied was 355. The mean age of the patients were 51.88 ± 23.22 years, and on average, 8.45 drugs had been prescribed for each patient. The total number of DDIs was 1597 among which class X was 1.4%, class D was 26.2%, and class C was 67.7%. Four hundred ninety-seven unique pairs of DDIs were identified. Age, number of prescribed drugs and length of stay in ICU were associated with prevalence of DDIs. Age and number of drugs were also identified as the risk factors of patients' discharge caused by death. Conclusion : DDIs can complicate health state of patients in ICUs and may increase the length of hospital stay. Setting up computerized systems to alert drug interactions in hospital wards and pharmacotherapeutic intervention by clinical pharmacist can minimize DDIs. [ABSTRACT FROM AUTHOR]

Background: Infertility is one of the critical health issues in Iran. There are more than 70 specialized infertility treatment centers in Iran, of which the Yazd Reproductive Sciences Institute, is one of the most important ones. Objective: This study aimed to determine the factors influencing infertile couples' choice of Yazd Reproductive Sciences Institute. Materials and Methods: This cross-sectional study was conducted on 275 infertile couples aged 18 and older, referring to Yazd Reproductive Sciences Institute, Yazd, Iran from September 2021 to March 2022. Data were gathered using a 2-part questionnaire. Data analysis was done through SPSS software. We used descriptive statistics, Kruskal- Wallis, Mann-Whitney, and t test for data analysis. Results: Most participants were individuals who came from other provinces of Iran (74.9%) and were referred to the Yazd Reproductive Sciences Institute. Among the 4 categories that influenced couples' decision to choose this center, factors related to the personnel and treatment staff received the highest score (75.83), while personal factors received the lowest score (65.76). The average score for factors related to doctors was 72.90, and for factors related to the center, it was 73.65. The satisfaction with personnel and treatment staff varied based on participants' education levels, with those who had lower levels of education reporting higher levels of satisfaction (p <0.001). Conclusion: The primary factors contributing to the success of the Yazd Reproductive Sciences Institute in attracting clients were the dedication and expertise of the staff, as well as the esteemed reputation of the doctors at the center. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate neurocognitive functioning, quality of life, and global functional performance in Ultra-High Risk (UHR) individuals compared to Familial High-Risk (FHR) individuals for developing schizophrenia. Method: An observational cross-sectional study was conducted using a convenient sampling method at Roozbeh Hospital in Tehran, Iran, from June 2017 to January 2020. The study included 40 UHR individuals based on the Structured Interview for Psychosis Syndrome (SIPS) interview, as well as 34 FHR individuals due to genetic risk. Neurocognitive functioning, quality of life, and global functional performance were assessed by using the Cambridge Automated Neuropsychological Test Battery (CANTAB) and Controlled Oral Word Association Test (COWAT), Quality of Life Scale (QLS), and Global Assessment of Functioning (GAF). Results: UHR individuals for schizophrenia demonstrated significant lower scores in phonemic and semantic verbal fluency (t = 6.218, P < 0.001; t = 4.184, P < 0.001, respectively), more total errors for spatial working memory (t = -5.874, P < 0.001), and fewer problems solved in minimum moves in Stocking of Cambridge (SOC) (t = -2.706, P < 0.01) compared to FHR individuals. Intra-Extra Dimension (IED) did not differ significantly between the two groups. Moreover, the study indicated significant GAF decline (F = 79.257, P < 0.001) and lower total score on the QLS (t = -10.655, P < 0.001) in UHR compared to FHR individuals. Conclusion: It is possible to differentiate UHR individuals from FHR individuals through neurocognitive, quality of life, and global functioning assessment. [ABSTRACT FROM AUTHOR]

Background. Due to pathological differences with other chronic diseases, breast cancer causes psychological and emotional problems, such as negative feelings, anxiety and stress. Objectives. The present study aimed to measure the perceived level of stress and its socio-demographic predictors among women with breast cancer. Material and methods. This cross-sectional study was conducted on 166 women receiving treatment for breast cancer in Ghazi Tabatabaie, Al-Zahra, Vali-Asr and Shams hospitals of Tabriz-Iran in 2017. A convenience sampling method was employed to select the participants. The required data was gathered using Cohen’s Perceived Stress Scale (PSS) and then statistically analysed using the independent t-Test, one-way ANOVA, the Pearson correlation coefficient and multivariate linear regression analysis. Results. The mean (standard deviation) score of perceived stress was 32.9 (5.2) out of 56. The multivariate linear regression analysis showed that income, education of the mother and marital satisfaction were predictors of perceived stress. These variables predicted 21.5% of the observed variance in the total score of perceived stress. Conclusions. The results indicated that the mean score of perceived stress was higher than average in women receiving treatment for breast cancer. Therefore, it is necessary to develop and execute strategies to reduce stress in such patients, especially those with a family history of breast cancer. [ABSTRACT FROM AUTHOR]

Foot-and-mouth disease (FMD) is a highly contagious animal disease caused by a ribonucleic acid (RNA) virus, with significant economic costs and uneven distribution across Asia, Africa, and South America. While spatial analysis and modeling of FMD are still in their early stages, this research aimed to identify socio-environmental determinants of FMD incidence in Iran at the provincial level by studying 135 outbreaks reported between March 21, 2017, and March 21, 2018. We obtained 46 potential socio-environmental determinants and selected four variables, including percentage of population, precipitation in January, percentage of sheep, and percentage of goats, to be used in spatial regression models to estimate variation in spatial heterogeneity. In our analysis, we employed global models, namely ordinary least squares (OLS), spatial error model (SEM), and spatial lag model (SLM), as well as local models, including geographically weighted regression (GWR) and multiscale geographically weighted regression (MGWR). The MGWR model yielded the highest adjusted R 2 of 90%, outperforming the other local and global models. Using local models to map the effects of environmental determinants (such as the percentage of sheep and precipitation) on the spatial variability of FMD incidence provides decision-makers with helpful information for targeted interventions. Our findings advocate for multiscale and multidisciplinary policies to reduce FMD incidence. [ABSTRACT FROM AUTHOR]

Background: Methanol poisoning is a worldwide phenomenon that has resulted in deaths and irreversible complications. However, studies show it is more prevalent in developing countries and areas with lower socioeconomic status. So, accurately recognizing socio-economic risk factors, increasing people's awareness about methanol poisoning, and proper hospital management will reduce its dangerous complications and mortality. Methods: This cross-sectional study was conducted retrospectively at Sina Hospital, a poisoning center and tertiary referral center in northwestern Iran, and investigated demographic findings and hospital management indicators through systematic random sampling between February 20, 2020, and September 22, 2022 (or the COVID-19 era). We assessed variable correlations using Spearman's correlation coefficient, Mann–Whitney U, and Kruskall–Wallis. Results: Out of 131 patients, 126 (96.2%) were males, and 5 (3.8%) were females. 45.5% and 30.3% of poisoning incidents occurred between the winter and spring, respectively. 67 patients (50.8%) were referred to this hospital due to vision complaints. Unfortunately, 10 patients (7.6%) passed away despite receiving care. Employed individuals were referred to the treatment facility more quickly than unemployed individuals (P-value = 0.01). Patients with medical insurance coverage were referred faster after consuming alcohol (P-value = 0.039). Older patients referred to the hospital later. (P-value = 0.006). Conclusions: Mortality and morbidity following methanol poisoning are likely to be affected by factors including access to medical care, financial stability, and employment status. Consequently, reducing mortality and morbidity requires attention to these concerns. [ABSTRACT FROM AUTHOR]

Background: The use of disinfectants and alcohol-based hand rubs (ABHR) to prevent COVID-19 transmission increased in the first wave of the infection. To meet the increased demand, the Iranian Ministry of Health issued an emergency use authorization allowing new manufacturers to enter the market, despite the limited capacity for surveillance of these products during COVID-19. Methanol poisoning outbreaks spread rapidly, and more people died from methanol poisoning than COVID-19 in some cities. The aim of this study was to analyze some ABHRs in the Iranian market to see if (a) ABHRs are standard and suitable for hand antisepsis and (b) contained potentially dangerous toxic alcohols. Method: Between February and March 2020, 64 brands of ABHR were conveniently collected from pharmacies, supermarkets, and shops selling hygienic products and analyzed using Gas Chromatography. World Health Organization and Food and Drug Administration guidelines were used to define minimum requirements for ABHR. For estimating the risk for acute methanol poisoning, we assumed a serum methanol concentration of 200 mg/L following ABHR ingestion was sufficient to cause intoxication. This threshold concentration would be achieved in an average 75-kg adult after consuming 8000 mg (or eight grams) methanol in 1–2 h. Results: The median [IQR] (range) concentration of ethanol, isopropanol, and methanol were 59% v/v [32.2, 68] (0, 99), 0 mg/L [0, 0] (0, 197,961), and 0 mg/L [0, 0] (0, 680,100), respectively. There was a strong negative correlation between methanol and ethanol contents of hand rubbers (r= -0.617, p < 0.001). Almost 47% of ABHRs complied with minimum standards. In 12.5% of ABHRs, high concentrations of methanol were observed, which have no antiseptic properties but could cause acute methanol poisoning if ingested. Conclusion: COVID-19 initiated a policy for distribution and use of ABHR with little control. As ABHR and masks are still accepted preventive measures of the disease, non-standard ABHR compositions may increase the population's risk to both COVID-19 infection and methanol poisoning. [ABSTRACT FROM AUTHOR]

This cross-sectional study evaluated patients' satisfaction with hospital meals in seven urban public hospitals using a validated questionnaire. The quality of food services based on the hospital standards was assessed using a checklist prepared by Iran's ministry of health. Of 800 subjects, the quality and quantity aspects of hospital meals, in general, were nearly satisfactory to the patients (mean score: 2.13, range: 1–3, SD: 0.39, 40% good and 36% moderate). The mean score of hospitals' food service quality based on hospital standards was 2.17 (range: 0–4, SD: 0.59). Females, younger patients and those with higher education level reported to be less pleased with hospital meal services. No relationship between patients' satisfaction and hospital food quality assessment based on hospital standards was found. [ABSTRACT FROM AUTHOR]

Background: Asthma is one of the most common chronic respiratory diseases. It is estimated that more than 400 million people will suffer from it by 2025. This study aims to determine the prevalence of asthma in East Azerbaijan and investigate the association between asthma and some environmental and demographic factors. Materials and Methods: This is a cross-sectional study based on a major Lifestyle Promotion Project (LPP) conducted in the districts of East Azerbaijan, including 2641 participants aged 15 to 65 years of the general population selected through probability proportional to size (PPS) multistage stratified cluster sampling. We used the World Health Survey questionnaire about doctor-diagnosed asthma to determine the prevalence of asthma. Age, smoking status, physical activity level, socioeconomic variables such as job and education level, and body mass index (BMI) were used as covariates in regression models. A questionnaire was used to obtain socio-demographic information and smoking status. The short form of the International Physical Activity Questionnaire was used to estimate the level of physical activity (IPAQ). Results: The mean age of participants was 40.9 ± 12.05 years including 1242 (47 %) males and 1399 (53 %) females. The prevalence of asthma was 3.3 %. The frequency of smokers was significantly higher in the asthmatic group compared with the non-asthmatic group (OR=2.33 [1.76-3.31]; p=0.03). There was no significant association between asthma and other demographic and lifestyle characteristics. Obesity has also played a significant role in the development of asthma. Conclusion: According to the results of this study, obesity and smoking have played a significant role in the development of asthma but there is no statistically significant relationship between socioeconomic and demographic factors. [ABSTRACT FROM AUTHOR]

Toxocariasis as a common neglected disease is the culprit of infecting all age groups. The current cross-sectional study was designed to assess the seroprevalence of toxocariasis and risk factors associated with seropositivity of Toxocara infection among the general population of adults in the Kavar district, south of Iran. A total of 1060 participants with an age range of 35 to 70 years from the Kavar region entered the study. Manual ELISA was utilized to detect anti-Toxocara-specific antibodies in their serum samples. In addition, demographic information as well as risk factors related to toxocariasis was collected from individuals who participated in the survey. The mean age of the participants was 48.9 (±7.9) years old. Out of 1060 subjects, 532 (50.2%) were men, and 528 (49.8%) were women. The overall Toxocara seroprevalence was 5.8% (61/1060). The prevalence of Toxocara seropositive cases was significantly different between males and females (p = 0.023). The seropositive rate for Toxocara infection was also significantly higher in housewives (p = 0.003) and subjects with learning disabilities (p = 0.008). Multivariable logistic regression revealed that housewives (OR = 2.04, 95% CI: 1.18–3.51, p = 0.010) and subjects with learning disability (OR = 3.32, 95% CI: 1.29–8.52, p = 0.013) were at increased risk of Toxocara infection. The findings of the current study depicted a noticeable seroprevalence of Toxocara infection in the general population in the Kavar district, southern Iran. An increased risk of toxocariasis has been associated with learning disabilities and being a housewife. All of the toxocariasis-positive cases had contact with animals, at some point in their life. In perspective, it is necessary to raise awareness of this infection among the population while surveilling Toxocara infection in high-risk groups. [ABSTRACT FROM AUTHOR]

Background: Clinical competency is the ability to integrate knowledge, skills, attitudes and values into a clinical situation and it is very important in nursing education, clinical settings, nursing management, and crises. This study aimed to investigate nurses' professional competence and its correlates before and during the COVID-19 pandemic. Methods: We conducted this cross-sectional study before and during the COVID-19 outbreak and recruited all nurses working in hospitals affiliated to Rafsanjan University of Medical Sciences, southern Iran, so we included 260 and 246 nurses in the study before and during the COVID-19 epidemic, respectively. Competency Inventory for Registered Nurses (CIRN) was used to collect data. After inputting the data into SPSS24, we analysed them using descriptive statistics, chi-square and multivariate logistic tests. A significant level of 0.05 was considered. Results: The mean clinical competency scores of nurses were 156.97 ± 31.40 and 161.97 ± 31.36 before and during the COVID-19 epidemic, respectively. The total clinical competency score before the COVID-19 epidemic was not significantly different from that during the COVID-19 epidemic. Interpersonal relationships (p = 0.03) and desire for research/critical thinking (p = 0.01) were significantly lower before the COVID-19 outbreak than during the COVID-19 outbreak. Only shift type had an association with clinical competency before the COVID-19 outbreak, while work experience had an association with clinical competency during the COVID-19 epidemic. Conclusion: The clinical competency among nurses was moderate before and during the COVID-19 epidemic. Paying attention to the clinical competence of nurses can improve the care conditions of patients, and nursing managers should improve the clinical competence of nurses in different situations and crises. Therefore, we suggest further studies identifying factors improving the professional competency among nurses. [ABSTRACT FROM AUTHOR]

Background: Bowel obstruction is a disorder in the passage of bowel contents, the etiology of which varies depending on temporal and geographical conditions. This study investigated the etiology of bowel obstruction in a large number of patients at an adult surgery referral center in southern Iran. Methods: In this cross-sectional study, we reviewed the medical records of all patients admitted to Shahid Faghihi hospital (Shiraz, Iran) between 2014 and 2020 with a diagnosis of small or large bowel obstruction. Patients with missing or obscure data on etiology were excluded. Data was collected on the patients' age, gender, history of relevant surgeries, comorbidities, cause of obstruction, site/type of obstruction, treatment, intensive care unit (ICU) admission, length of hospital stay, and outcome. Statistical analyses were made using SPSS v. 25.0. Results: A total of 2781 bowel obstruction patients (61.4% males, 38.6% females) with a median age of 58 (IQR 43-71) years were studied. Most responded to non-surgical treatment (61.3%). While the obstruction was mostly partial (65.5%), 94.4% of patients with complete obstruction required surgery. Small bowel obstruction (SBO) was almost three times more prevalent than large bowel obstruction (LBO). Adhesion bands were the leading cause of SBO (66.77%), while LBO was primarily due to colorectal tumors (33.9%). Conclusion: The predominant etiology of LBO was colorectal cancer, suggesting that policymakers should improve surveillance programs to detect the condition earlier. Regarding SBO, the leading cause was adhesion bands, indicating the necessity of further efforts to reduce the rate of adhesions following intra-abdominal operations. [ABSTRACT FROM AUTHOR]

Cystic echinococcosis (CE) is a common zoonotic infection in all provinces of Iran, especially in areas where people live on agriculture and animal husbandry. The current cross-sectional population-based study is aimed at determining the seroprevalence of CE in Kavar County, Fars province, southern Iran. Blood samples were collected from 1500 individuals (749 males and 751 females). Anti-hydatid cyst antibodies were detected, using a recombinant B8/1 antigen of Echinococcus graunlosus in an ELISA system. Multivariate logistic regression analysis was used to find out the independent risk factor for CE seropositivity. Anti-hydatid cyst antibodies were detected in the sera of 131 out of 1500 participants, corresponding to a seroprevalence rate of 8.73%. With a statistically significant difference (p < 0.05), the seroprevalence of hydatid cyst in males and females was 5% and 7%, respectively. Differences in the seropositivity of hydatid cysts were also statistically significant by occupation (p < 0.05). The seroprevalence of hydatid cyst was significantly higher in the age group of 35-45 years than in other age groups (p < 0.05). Multivariate logistic regression showed that only age was associated with seropositivity to CE (OR = 2.23 , 95% CI: 1.33-3.72). Moreover, there was a statistically significant association between seropositivity to hydatid cysts and underlying diseases such as hypertension (p = 0.049) and fatty liver (p = 0.048). The findings of this study indicate that the seroprevalence rate of CE is relatively high in the Fars province, southern Iran, and this high rate of infection is mainly linked to people's jobs and lifestyles. [ABSTRACT FROM AUTHOR]

Introduction: Communication skills and acceptable levels of spiritual intelligence (SI) are the prerequisites of the nursing profession, which can significantly impact the individual and organizational performance of nurses. This study aimed to investigate the competency and self-efficacy of communication and its relationship with the SI of nurses. Methods: This cross-sectional study was conducted in 2021 and included 312 nurses working in a COVID-19 hospital in the south of Iran. The data collection instruments were the Standard Communication Competence Scale, Communication Self-Efficacy, and SI Questionnaires. Data were analyzed with SPSS software version 23 using descriptive and inferential statistics, and t-test, ANOVA, Pearson's correlation coefficient, and multiple linear regression were performed at 5% significance level. Results: The mean scores of nurses' communication competence, communication self-efficacy, and SI were 89.11 ± 7.32 out of 180, 64.45 ± 5.61 out of 120, and 147.13 ± 11.26 out of 210, respectively. A direct and significant correlation was observed between competence (r = 0.527, p<0.001) and communication self-efficacy (r = 0.556, p<0.001) with spiritual intelligence. The dimensions of spiritual intelligence, including the ability to deal with and interact with problems, self-awareness, love and affection, general thinking and doctrinal dimension, and dealing with moral issues, were identified as predictors of nurses' communicative competence and self-efficacy (p<0.05). There was a positive and significant correlation between nurses' competence and self-efficacy with their age (p<0.05). The nurses' mean communication competence and self-efficacy score were different regarding their level of education and the number of shifts (p<0.05). The mean scores of self-efficacy revealed a statistically significant difference between the participants' gender and the number of patients under observation (p<0.05). Moreover, the nurses' SI significantly correlated with age, and the mean scores of this intelligence had statistically significant differences regarding gender (p<0.05). Conclusion: The nurses' communication competence and self-efficacy were at a moderate level. Considering the correlation and predictive role of SI and its dimensions, it is recommended to promote problem-solving skills, improve self-awareness, and pay attention to moral standards to nurture communication competence and self-efficacy among nurses. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to assess the status of iron stores and the frequency of iron deficiency anemia in Celiac disease (CD) patients referred to the Golestan Research Center of Gastroenterology and Hepatology, Gorgan, Iran. Background: Studies have shown that nutritional deficiencies affect 20-38% of patients with CD due to malabsorption and as a result of a gluten-free diet. Methods: In this study, 59 out of 100 CD patients were assessed. The presence and severity of anemia were determined using the concentration of serum hemoglobin according to WHO criteria. The status of body iron stores was also assessed based on serum ferritin levels. Results: Mean and SD of age, duration of disease, serum hemoglobin, ferritin, TIBC, and serum iron were 39.9±11.9 years, 69.8±45.4 months, 12.6±1.99 g/dl, 54.3±55.3 mg/dL, 365.9±49.1 μg/dL, and 84.1±37.1 μg/dL, respectively. 68.42% had no anemia, 19.3% had mild anemia, 8.77% had moderate anemia, and 3.51% had severe anemia. 25.42% of patients had depleted iron stores, 71.19% had normal iron stores, and 3.39% were exposed to iron overload. There was a statistically significant correlation between serum hemoglobin and the duration of disease diagnosis (P=0.037, r=0.302). Conclusion: In this study, 31.58% of CD patients on a gluten-free diet had some degree of anemia. In addition, 25.42% of patients had depleted iron stores. These results suggest that CD patients should be evaluated for iron status, even with a gluten-free diet. [ABSTRACT FROM AUTHOR]

Iran is one of the countries that have been confronted with the SARS-CoV-2 epidemic since February 2020. This study aimed to determine the levels of specific IgG antibodies against SARS-CoV-2 among healthy blood donors to estimate the burden of the epidemic. A serial cross-sectional study was conducted on blood donors who referred to 31 main blood donation centers in different provinces during the third weeks of September, October, and November 2020. A questionnaire was filled out to collect socio-demographic characteristics, history of contact with COVID-19 patients, and history of COVID-19. A blood sample was collected from each participant to assess the antibodies against SARS-CoV-2 using the ELISA method. The crude prevalence of anti-SARS-CoV-2 IgG was calculated. Then it was weighted based on the gender and age groups of the general population in each province and adjusted for test sensitivity and specificity. During three time points of the study, 3840, 3697, and 3152 participants enrolled. The seroprevalence of SARS-CoV-2 IgG antibodies was 19.59% (17.18–22.00), 22.67% (20.70–24.65), and 32.63% (29.93–35.33) over the three rounds of the study. We found an association between the seropositivity and the highest educational level; AOR 0.76 (0.63–0.93), history of close contact with COVID-19 patients; AOR 1.69 (1.35–2.11), and history of confirmed SARS-CoV-2 infection; AOR 8.86 (5.38–14.60). This study showed that about one-third of the population had been infected with COVID-19. Furthermore, a significant upward trend in seroprevalence was observed. The predisposing factors indicate the importance of public health. [ABSTRACT FROM AUTHOR]

PURPOSE: The purpose is to determine the prevalence of primary open-angle glaucoma (POAG) and study the relationship of smoking and other potential risk factors with POAG. METHODS: This is a cross-sectional study based on the Azar cohort databases (including the eye cohort study) in Iran, including 11,208 participants aged 35-70 years. According to the questionnaire, participants were divided into five groups in terms of smoking. Ophthalmologic examinations were performed in two steps. The first step was performed by an optometrist, and all referred participants underwent a complete ophthalmological examination in the second step, then after POAG cases were diagnosed using Criteria of the International Society of Geographic and Epidemiological Ophthalmology. RESULTS: Of the participants, 4992 (44.5%) were male and 6216 (55.5%) were female, with a mean age of 50.1 ± 9.27 years. The prevalence of POAG in our study population was 1%, which included 58 (1.2%) males and 58 (0.9%) females. There was no significant difference between the two groups in terms of the prevalence of different smoking categories in both genders. There was a statistically significant difference between the two groups in both genders in terms of diabetes mellitus (DM) after adjusting for age and there was a statistically significant difference between the two groups in the male population in terms of triglycerides ≥150 mg/dl. CONCLUSION: Findings of this study indicated that there is no association between cigarette smoking in different doses and a history of smoking with POAG. Other factors, such as aging and underlying diseases, including DM and hypertriglyceridemia, have a statistically significant association with POAG. [ABSTRACT FROM AUTHOR]

Sexual violence increases the risk of adverse health outcomes among female sex workers (FSWs). Using data from the 2015 national bio-behavioral survey, we explored the experience of sexual violence and its associated factors among Iranian FSWs. Lifetime and recent sexual violence were reported by 40.1% and 16.9%, respectively. History of substance use, ever engaging in anal sex, engaging in group sex within the last year, a high number of clients, recent unstable housing, and incarceration increased the likelihood of experiencing recent sexual violence. These findings underscore the need for community-empowerment and policy-level interventions to address violence among FSWs in Iran. [ABSTRACT FROM AUTHOR]

Background: Breast self-examination (BSE) is an important part of health care for all women in every stage of life. This study aimed to investigate the effect of theory of planned behavior (TPB) on doing BSE in a sample of Iranian women. Methods: A cross-sectional study was carried out to examine the factors affecting the BSE in 400 women. Then, a quasi-experimental study was conducted on 200 subjects (100 in experimental group and 100 in control group). The educational intervention for the experimental group consisted of 8 training sessions. A questionnaire including demographic characteristics, knowledge, and constructs of TPB was used to measure BSE performance before and 6 months after the intervention. Constructs of attitude, subjective norms, and perceived behavioral control predicted the intention to do the BSE. Results: The mean age of the subjects was 31.65 ± 7.59 years. The studied variables predicted 38.7% of behavioral intention (P <.001, odds ratio = 0.387). Six months after the intervention, the experimental group showed a significant increase in the knowledge, attitude, perceived behavioral control, subjective norms, intention, and BSE performance compared with the control group (P <.001). Conclusions: This study showed that educational intervention based on the TPB was effective in promoting breast cancer screening behavior such as BSE. Therefore, it is suggested that health educators and health care planners use educational texts based on these constructs of TPB to increase their influence on individuals via screening behavior for breast cancer. [ABSTRACT FROM AUTHOR]

Aim: Vulvovaginal candidiasis (VVC), is a common fungal infection that remains a global concern. The objectives of this study were molecular identification and assessment of the antifungal susceptibility profile of Candida species, causing VVC in southeast Iran. Methods: A cross‐sectional investigation was carried out on 119 nonpregnant females suspected of VVC between February 2019 and May 2021. Yeast samples were characterized to the species level by conventional and molecular methods. All Candida isolates were examined for in vitro susceptibility profile to six conventional antifungal drugs using Clinical and Laboratory Standards Institute guidelines. Results: Out of 119 subjects, 52 (43.7%) cases were affected by VVC, out of whom 11 (21.15%) cases had recurrent vulvovaginal candidiasis (RVVC). The species distribution was as follows; Candida albicans (n = 21; 40.4%), C. glabrata (n = 11; 21.2%), C. tropicalis (n = 9; 17.3%), C. parapsilosis (n = 5; 9.7%), C. africana (n = 3; 5.7%), C. famata (n = 1; 1.9%), C. lusitaniae (n = 1; 1.9%), and C. dubliniensis (n = 1; 1.9%). The resistance rate of Candida isolates to fluconazole, itraconazole, and voriconazole were 15.38%, 11.5%, and 3.8%, respectively. Resistance to fluconazole was obtained in 46% (5/11) of RVVC cases but only in 7% (3/41) of VVC cases. Conclusion: This study demonstrated that the majority of VVC cases were caused by non‐albicans Candida species which also were resistant to some antifungal agents. Hence, our findings revealed the importance of conducting periodical epidemiological studies to determine changes in species distribution. Moreover, for effective management of treatment and infection, it is imperative to evaluate the susceptibility profiles of Candida species isolated from VVC patients. [ABSTRACT FROM AUTHOR]

A cross-sectional study with a convenience sample of 241 patients with breast cancer was conducted to investigate death depression and its explanatory factors in Iranian women who were diagnosed and undergoing treatment for breast cancer. Patients with significantly higher death depression were those who were housewives (β = 0.6, p = 0.016), unskilled workers (β = 15.8, p = 0.002), and retired (β = 13.1, p = 0.002) as compared with those who were professionally employed with higher socio-economic status (β = 17.4, p = 0.002); and those receiving combination therapy as compared to surgery only (β = 6.3, p = 0.02). For patients with higher spiritual health scores, death depression was significantly lower (β = −0.2, p < 0.001). [ABSTRACT FROM AUTHOR]

Background and Aim Genetic and environmental factors are known to be related to the development of childhood Eczema. We aimed to assess the ecological factors associated with the prevalence of Eczema among children using the ISAAC questionnaire. Methods & Materials A total of 1600 primary school girls and boys were selected and examined by multistage random sampling in this cross-sectional study. Data were collected and completed using the International ISAAC Questionnaire, including demographic questions and risk factors through interviews with parents, especially the student’s mother. The data were analyzed in SPSS19 software using the Chi-square test and multiple logistic regression. Ethical Considerations This study was approved by the Ethics Committee of Zahedan University of Medical Sciences (Code: REC.1397.481). Results The prevalence of current Eczema was 10.4% (CI95% 8.9-11.9). Co-morbidity with Asthma and Rhinitis was 82.8% and 74.5%, respectively. In multiple logistic regression models, history of allergies in family members (OR: 2.35 CI95%:1.53-3.59), father snoring (OR: 3.00 CI95%:1.98-4.55), Keeping any animal in (OR: 1.6 CI95%:1.002-2.58), family size (OR:0.85 CI95%:0.68-0.95), exposure to tobacco smoke at home (OR:2.84 CI95%:1.18-6.81), showed a significant relationship with the occurrence of students’ Eczema. Conclusion Exposure to tobacco smoke at home, keeping any animal at home are effective factors in the prevalence of Eczema in children. By eliminating these factors, the prevalence of this disease can be reduced. However, the mothers have the most crucial role in screening and early diagnosis of Eczema in school children regarding determinants in this study. According to the results of this study, it is suggested that parents’ education, especially mothers, be emphasized by paying attention to these favorable factors. [ABSTRACT FROM AUTHOR]

Aims: The use of automatic teller machines (ATMs) daily has increased the chances of hand-borne transmission of microorganisms to the machine's surfaces, and they can have an important role in microorganisms' transmission to individuals. This study aimed to investigate microbial contamination in ATMs in the center of Iran. Materials and Methods: This cross-sectional study was used to collect samples from the keyboards and monitors of the ATMs in Kashan. After 24 h of incubation, the swabs were inoculated on different selective media, including MacConkey agar and blood agar. Microbiological tests were used to confirm bacterial isolates. Results: The most frequently contaminated ATMs were government banks, with 69% contamination. The most frequently isolated bacterium was Staphylococcus epidermidis) 37/77%). The other bacteria were also identified, including Bacillus spp. (17/77%), Escherichia coli (7/77%), Micrococcus spp. (7/77%), Myroides odoratus (4/44%), Klebsiella pneumoniae (2/22%), Staphylococcus aureus (2/22%), Staphylococcus saprophyticus (1/11%), and Klebsiella oxytoca (1/11%), respectively. Conclusions: The most tested ATM keyboards in this study were contaminated with at least one microorganism. According to our results, it is recommendable to disinfect the hands after entering public places to hinder the spread of critical pathogens. [ABSTRACT FROM AUTHOR]

Background: The growing prevalence of depression has become a major public health problem. There is limited evidence regarding the relationship between dietary behaviors and depression. The present study was designed to evaluate the association between dietary behaviors and depression score.Methods: A total of 933 Iranian adolescent girls aged 12 to 18 years were included in this cross-sectional study. Depression severity score was assessed using a validated Persian version of Beck's depression inventory. Dietary behaviors were pre-defined and assessed in ten domains using a standard questionnaire. To investigate the association between dietary behaviors and depression score, the linear regression analysis in crude and adjusted models was used.Results: 67.7% of participants had no or minimal depression symptoms and 32.3% of participants were categorized with mild-to-severe depression symptoms. There were significant inverse relationships between main meal consumption (Beta: -0.141; 95% CI: - 3.644 to - 1.000; P = 0.001), snack consumption (Beta: -0.100; 95% CI: - 2.400 to - 0.317; P = 0.002), regular meal consumption (Beta: 0.23; 95% CI: 0.13-0.42; P = 0.001) and food chewing (Beta: -0.152; 95% CI: - 2.279 to - 0.753; P = 0.03) with depression score. These associations remained significant after adjustment for confounding variables. In addition, frequency of intra-meal fluid intake (Beta: 0.096; 95% CI: 0.288 to 1.535; P = 0.004) and spicy foods consumption (Beta: 0.076; 95% CI: 0.098 to 1.508; P = 0.02) were directly associated with depression score in the crude model. These significant relations were disappeared in full adjusted model. No significant association was found between breakfast consumption, intake of fried foods, chewing ability, and tooth loss with depression score (P > 0.05).Conclusions: Significant associations were observed between specific eating behaviors with depression score. Prospective studies are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Background and Objectives: Spiritual well-being is very important in adaptation and peace of mind, especially in certain periods of life. Middle age is associated with many biological, psychological, and social changes and problems such depression and hopelessness. This study aims to investigate the relationship between spiritual well-being, depression, and hope in middleaged women in Qom, Iran. Methods: This is a descriptive-analytical study with cross-sectional design that was conducted on 100 middle-aged women referred to community health centers in Qom city, who were selected by a convenience sampling method. Data were collected by three questionnaires including Paloutzian and Ellison's spiritual well-being scale (SWBS), Beck' depression inventory (BDI), adult hope scale (AHS), which were completed through interview. Data were analyzed in SPSS version 21 software using regression analysis. Results: The Mean±SD total scores of SWBS, BDI, and AHS were 73.43±1.25, 31.10±0.91, and 16.26±0.34, respectively. There was a significant relationship between spiritual well-being and depression and between spiritual health and hope (P=0.001). Moreover, spiritual well-being and hope had a significant relationship with depression (P=0.001). Conclusion: Middle-aged women with high spiritual well-being have less depression and more hope. It is recommended to pay more attention to spiritual well-being of these women to maintain their mental health and increase their hope. [ABSTRACT FROM AUTHOR]

Background and Objectives: Despite the increased sensitivity of screening tests, the HBV can be transmitted during the window period and occult hepatitis B infection. The purpose of this study was to evaluate HBV markers and prevalence of OBI among HBsAg negative blood donors in Golestan province. Materials and Methods: Anti-HBc (IgM and IgG), anti-HBs and anti-HBe tests on 4313 serum samples (HBsAg negative) were performed by ELISA method. Also, all samples for the presence of HBV- DNA were tested by using NAT methods. SPSS software and chi-square test were used for data analysis. Results: Of the 4313 samples, 384 (8.9%) sera were anti-HBc positive. Also, of 384 anti-HBc positive samples, 302 (78.65%) were anti-HBs positive and 152 (39.6%) were anti-HBe positive. Thirty-nine (0.90%) samples were anti-HBc positive, anti-HBs negative and anti-HBe negative. HBV-DNA was not detected in any of specimens. Conclusion: Based on the results of retesting the isolated anti-HBc samples that after one year recalling, had undetectable HBV-DNA and for the prevention of the decreasing of healthy blood donation (due to false positive anti-HBc) and preservation of the blood supplies; Individual Donor Nucleic Acid Testing (ID-NAT) along with the anti-HBc testing for the improving blood safety is recommended. [ABSTRACT FROM AUTHOR]

Introduction: The quality of nursing services is one of the main factors accelerating patients' recovery. The present study aimed to examine patients' perceptions of the quality of nursing services in the teaching hospitals of Iran. Methods: This cross-sectional research was a descriptive-analytical study conducted in 2021, in which 1067 patients were selected as the research sample. The Qualipak nursing quality questionnaire (QUALPAC) was used to collect the required data. Data were analyzed using t-test, ANOVA, and Pearson correlation coefficient using SPSS software version 23. Results: From the patients' perspective, the mean and standard deviation of the quality of nursing services was 191.47 ± 19.51. Among the quality dimensions, all services quality: psychosocial (91.34 ± 9.34), physical (65.72 ± 10.18), and communication (34.41 ± 6.21) were placed at the moderate level. A significant association was found between patients' age and nursing service quality. The perceived nursing service quality was subject to sex (P = 0.01, t = 1.921) and place of residence (P = 0.02, t = 1.873). Conclusion: According to the findings, the quality of nurses 'care was "moderate" from the patients' perspectives. Planning is recommended to reinforce and promote the quality of nursing services. [ABSTRACT FROM AUTHOR]

Background: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has entered our lives with the fear of outbreak, death, and recurrence. Our objective in this study is to evaluate the epidemiological features of Coronavirus Disease 2019 (COVID-19) infection and death in Fars province, Iran. Methods: A cross-sectional study was conducted from February 18th to September 30th, 2020, where age, history of underlying diseases, sex, community-wide quarantine, nationality, close contact, pregnancy, medical staff job, traveling, and residency were compared between alive and deceased groups. Data were analyzed using IBM SPSS software, version 22.0, and the significance level was set at 0.05. Results: Regarding 57958 new cases of COVID-19, the basic reproduction number (R0) was estimated as 2.8, requiring a minimum of 65% immunization to reach herd immunity. Moreover, an R0=0.36 was required to reach the endemic state in the region. The incidence, mortality, fatality, and recurrence rates of COVID-19 were estimated as 1347.9 per 100,000 dwellers, 209.5 per 1000,000 dwellers, 1.6 %, and 3.1 per 100,000 dwellers, respectively. Age, history of underlying diseases, urban residency, and the male sex were significantly higher in the deceased group (OR=1.09, 5.48, 1.24, and 1.32; All Ps<0.001, <0.001, 0.005, and <0.001, respectively). In addition, the recurrence rate among positive cases was estimated as 0.23% with a median±inter-quartile range equal to 84±46.25 days. Community-wide quarantine was shown to be a protective factor for death due to COVID-19 (OR=0.58, P=0.005). Conclusion: Community-wide quarantine blocks the transmission of COVID-19 effectively. COVID-19 enjoys no solid immunity. History of underlying diseases, the male sex, urban residency, and age were among the most significant causes of death due to COVID-19. Further investigations are recommended on the genetic structure of SARS-CoV-2, treatments, and vaccination. [ABSTRACT FROM AUTHOR]

Objective: The recent escalated numbers of subjected COVID-19 patients and mortality rates have alerted the general population and authorities to its effects not only on physical health but also on different aspects of the society such as mental health. This study assesses the general mental health and immediate psychological impacts in hospitalized patients with COVID-19. Method: In this cross-sectional study, 88 patients from two tertiary hospitals in Tehran agreed to complete the surveys. The Impact of Event Scale-Revised (IES-R) and 12 item General Health questionnaire (GHQ-12) were used to evaluate mental health and impact of disease. Epidemiological and sociodemographic information entailing underlying diseases was assess by a researcher-made questionnaire. Results: We found that the psychological impact of the current pandemic is mild to moderate. During the initial phase of the pandemic, the intellectual engagements, inducing post event stress is not yet entirely developed. However, patients had a moderate to high probability of psychiatric morbidity with 63.6% and 28.4%, respectively. Conclusion: The effect of such viral pandemic on mental health is inevitable. As we conducted the study in the dire times of the outbreak, patients showed a high probability of psychiatric morbidity. On the other hand, since the study was done in the initial phase of the epidemic, we detected mild effects of the epidemic on PTSD in COVID-19 patients. Furthermore, several psychosocial protective programs should be implicated to address the mental complications. [ABSTRACT FROM AUTHOR]

Objective: COVID-19, which is an international concern by far, had fundamental impacts on mental health of medical staff. Healthcare workers are the high-risk group to endure the emotional outcomes brought about by the outbreak. This study assesses the mental consequences of healthcare workers during the acute phase of COVID-19 pandemic in Tehran. Method: We conducted a cross-sectional study on healthcare workers from two tertiary referral hospitals in Tehran province. A total of 222 of the staff participated in the study. Our questionnaires comprised Impact of Event Scale- Revised (IES-R) and 12-item General Health Questionnaire (GHQ-12), which were handed to participants to obtain data on their general mental problems in addition to the psychological impacts of the evolving virus on this particular group. Epidemiologic and sociodemographic information of participants, level of perceiving exposure to disease, and underlying diseases of each of them were gathered during the recruitment period. Results: Results showed high probabilities (98.2%) in mental disorders among healthcare workers. Since our study was done during the initial phase of the pandemic, development of mental issues due to the newly emerged infectious virus was expected. However, we recorded mild (41.4%) to moderate (31.5%) impact of this novel virus. The possibility of having mental problems was much higher in females, assistant nurses, individuals with lower education, and those who provided care for COVID-19 patients. Conclusion: COVID-19 has brought about increased distress among healthcare workers. Noticeably, the forefront group in combating this virus bear the most emotional complications. Thus, efforts should be taken into practice to provide proper psychological support for this vulnerable group. [ABSTRACT FROM AUTHOR]

Background. Given the increasing prevalence of primary tooth caries in Iran and the importance of providing evidence- and theory-based family-centered prevention programs, the present study is aimed at determining the family-centered social cognitive factors preventing deciduous tooth caries among children using the intervention mapping protocol. Methods. This cross-sectional study was performed on 240 Iranian mothers in Ilam who were randomly selected to participate in the study. The data were collected using a self-designed questionnaire including items on demographic information and social cognitive constructs (knowledge, attitude, perceived severity, perceived benefits, perceived barriers, practice guidance, perceived self-efficacy, behavior intention, subjective norms, and social norms). The questionnaire was completed by mothers, and the data were analyzed by performing one-way analysis of variance and linear regression. Results. The results obtained from linear regression analysis showed that perceived self-efficacy (B = 0.295 , p < 0.001), perceived barriers (B = 0.084 , p < 0.028), practice guidance (B = 0.774 , p < 0.001), and social norms (B = 0.137 , p < 0.020) accounted for 71% of the behavioral intention variance and were the most important predictors for preventing primary tooth caries among children. Conclusion. The findings suggest that perceived self-efficacy, perceived barriers, practice guidance, and social norms are essential for developing family-centered programs to prevent primary tooth caries in children. [ABSTRACT FROM AUTHOR]

This cross-sectional study aimed to determine the attitude, intention and aspects of marriage among students. There was a significant relationship between gender and general attitude toward marriage and, mean score of male students' attitude toward marriage was higher (P <.05). Based on the results of path analysis, sub-scales of general attitude toward marriage and Aspects of Marriage, explained 40% of the variance for the Intent to Marry. The results showed that students' attitude toward marriage was moderate and their marriage intention was not high. According to the results, it is necessary that implemented the training courses to change attitudes and create realistic expectations about marriage in the students. [ABSTRACT FROM AUTHOR]

Background One of the main problems in patients with Helicobacter pylori (H. pylori) infection is the recurrence of this disease after eradication. Objective This study aims to evaluate the recurrence rate of H. pylori infection 3-5 years after successful eradication in Iran. Methods In this descriptive cross-sectional study, participants with a history of H. pylori infection who had been treated in the past 3-5 years were examined for the recurrence of this infection. After obtaining their consent, demographic and clinical information was recorded through interviews and based on medical records. To confirm the recurrence rate, the carbon-14 urea breath test was performed. Results Out of 169 participants, 41.4% were male, 86.9% were living in urban areas, 91.1% were non-smokers, and 3.6% had a history of alcohol consumption. The results of the urea breath test showed that only one patients (0.6%) had experienced recurrence after complete treatment. Conclusion The recurrence rate of H. pylori infection in Iran is much lower than in the developed countries. [ABSTRACT FROM AUTHOR]

Introduction: Out-of-pocket (OOP) is among the payment methods in Iran's health system. The present study aimed to examine the OOP treatment costs for patients with COVID-19 in Iran. Methods: A descriptive-analytical, cross-sectional study was conducted in 2021. In this study, the cost records of 550 patients with COVID-19 hospitalized in a referral center of COVID-19 were selected using the stratified random sampling method. The required data were collected using a researcher-made questionnaire. Data were analyzed by t-test, ANOVA, and Pearson's correlation coefficient in SPSS software version 23 at p = 0.05. Results: The total direct costs were 1,037,992.15 US $. Moreover, the shares of patients (OOP), basic insurance, government subsidy, supplementary insurance, discounts, and out-of-government subsidy in the total direct costs were US $ 92,231.21, 746,932.99 US $, 155,127.08 US $, 39,690.25 US $ and 4010.61 US $, respectively. In addition, the results confirmed that there was a positive and significant relationship between the patients' OOP payments and the length of stay. It also found that the patients' OOP payments are subject to the type of insurance program and discharge method. Conclusion: According to the results, 8.89% of the total direct costs were directly paid out of the patients' pockets. The research findings confirm the urgent need to make decisions and implement effective interventions for COVID-19 disease by controlling risk factors and exploiting other countries' successful experiences and international organizations' recommendations to decrease the prevalence of the infected and consequently reduce the financial pressure of the disease on patients by approving the expansion of the insurance organizations' role. [ABSTRACT FROM AUTHOR]

Background: Clinical education is the heart of medical education. It is one of the most important manifestations of teaching and learning in professions relating to medical sciences, leading to learners' clinical competency. This study was done to investigate general physician graduates' knowledge, performance, and clinical competency before entering the field of clinical activities. Methods: In this descriptive cross-sectional study, the scores of different stations of the Objective Structured Clinical Examination (OSCE), held at the end of the general medicine course in Iran, were collected at Mashhad University of Medical Sciences. Totally, 266 students who participated in six periodicities of clinical competency examinations were included in the study by the census method. The clinical competency of general physician graduates assessed in the scopes were determined by the General Medical Education Council, including problem-solving, communication skills, practical action, taking the history, and performing physical examinations by the OSCE. The data were analyzed by SPSS software using descriptive and inferential statistics. Results: The effect of different scopes of the OSCE (F(3,5652) = 7.022 and P = 0.001) and participants' performance based on their critical and noncritical indicators (T = 1.976 and P = 0.04) are significant with 95% confidence interval. This suggests that participants' performance varies in different scopes of the clinical examination, including problem-solving, communication skills, practical action, taking the history, and performing physical examinations. Conclusions: The differences in the clinical competencies of general physician graduates in mentioned scopes were significant. This emphasizes the need to examine their essential skills to achieve the minimum competencies expected of a future physician before entering the field of clinical activity. [ABSTRACT FROM AUTHOR]

Background: Prostate cancer is a major malignancy worldwide among men; it is the fourth leading cancer in both genders. This study investigated the pathologic factors of radical prostatectomy (RP) specimens. Method: About 578 men underwent RP during five years in Shiraz University hospitals. We recorded the following clincopathological parameters: tumor type and stage, Gleason score (GS), grade, tertiary pattern, ISUP, surgical margin, lymph node (LN) involvement, lymphovascular invasion, seminal vesicle involvement, extraprostatic extension (EPE), vas deferens invasion, perineural and pseudocapsular invasion, bladder neck involvement, and age. Results: The mean age of participants was 63.87 ± 6.95 years. Most had pathologic T2N0Mx (73 %) diseases; the most GS was low-risk GS ≤ 6 (47.4%). Surgical margin status was free of tumors in 72.5% and among those with positive margins; the most involved site was the apex in 18.3%. Single and dual LN involvements were the most prevalent patterns. 5.9% of the patients had EPE. We found perineural and pseudocapsular invasions in 59.9% and 29.9%, respectively. There was a strong correlation between the clincopathological parameters, stage, and ISUP. Perineural invasion, pseudocapsular invasion, and tertiary pattern 5 increased with advanced age (P < 0.0001). The GS 8 to 10 increased with the increase in age (P =0.001). Conclusion: A strong correlation existed between the clincopathological parameters, stage, and ISUP. Additionally, perineural and pseudocapsular involvement and tertiary pattern 5 had a strong relationship with advanced age. [ABSTRACT FROM AUTHOR]

Background: Considering that exposure to sunlight in childhood and adolescence has an important role in skin cancer, so it seems that training protective behaviors in this period is more effective.Objectives: To survey the application of protection motivation theory (PMT) on skin cancer preventive behaviors among students in rural areas of Fasa city, Iran.Methods: This study was done in two stages: Phase I of this study, the descriptive-analytic and cross-sectional study was conducted in 2018 to investigate the predictive value of the protection motivation theory on skin cancer preventive behaviors. In the second stage, a quasi-experimental interventional study was conducted on 400 primary school students in 2019. The educational intervention was performed in the experimental group for 8 sessions. Data were collected using a demographic information questionnaire and protection motivation theory before and six months after the intervention.Results: The constructs of protection motivation theory predicted 58.6% of skin cancer preventive behaviors. The results indicated that there was no significant difference between the two groups in terms of knowledge, perceived sensitivity, perceived severity, reward, fear, protection motivation, response efficacy, self-efficacy, response costs, and the skin cancer preventive behaviors in before the intervention (p > 0.05). However, six months after the intervention, the experimental group showed a significant increase in each of the mentioned constructs and skin cancer protective behaviors (p < 0.05).Conclusion: This study showed the effectiveness of the intervention based on the PMT constructs in adoption of skin cancer preventive behaviors in 6 months' post intervention in primary school students. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease (CVD) is the most prevalent comorbid condition among patients with diabetes. The objective of this study is to determine the incremental healthcare resource utilization and expenditures (HRUE) associated with CVD comorbidity in diabetic patients. Methods: In a cross-sectional study, patients receiving antidiabetic drugs were identified using the 2014 database of the Iran Health Insurance Organization of East Azerbaijan province (Iran). The frequency of HRUE was the main outcome. Outcome measures were compared between diabetic patients with and without CVD comorbidity during 2014-2016. The generalized regression model was used to adjust for cofounders because of a highly skewed distribution of data. Negative binomial regression and gamma distribution model were applied for the count and expenditure data, respectively. Results: A total of 34,716 diabetic patients were identified, of which 21,659 (63%) had CVD comorbidity. The incremental healthcare resource utilization associated with CVD compared to non- CVD diabetic patients for physician services, prescription drugs, laboratory tests, and medical imaging was 5.9±0.34 (28% increase), 46±1.9 (46%), 12.9±0.66 (27%), and 0.16±0.40 (7%), respectively (all P<0.001). Similarly, extra health care costs associated with CVD comorbidity for physician services, prescription drugs, laboratory tests, and medical imaging were 10.6±0.67 million IRR (294.4±18.6 USD) (50% increase), 1.44±0.06 million IRR (40±1.6 USD) (32%), 8.36±0.57 million IRR (232.2±15.8 USD) (58%), 0.51±0.02 million IRR (14.1±0.5 USD) (24%), and 0.29±0.02 million IRR (8±0.5 USD) (22%), respectively (all P<0.001). Conclusion: CVD comorbidity substantially increases HRUE in patients with diabetes. Our findings draw the attention of healthcare decision-makers to proactively prevent CVD comorbidity in diabetic patients. [ABSTRACT FROM AUTHOR]

COVID-19 disease has quickly become a major threat and epidemic in the world. Many people are experiencing psychological disorders due to the rapid spread of the COVID-19 disease. The present study aimed to investigate the psychosocial status of the Iranian citizens during the prevalence of COVID-19. One thousand one hundred and sixteen citizens of Rafsanjan city participated in the cross-sectional study from March 15 to 30, 2020. The data were collected using demographic and COVID-19 related-items, and Health General Questionnaire (GHQ −28). The results showed that 35% of the participant had mental health problems. All participants had social functioning disorder, while 22.8% had physical symptoms, 26.8 had anxiety symptoms and sleep disorders. In addition, the risk of psychosocial disorder was higher in females, those who were living in the city, earning less than 1 million, thinking of being at risk for infection with the coronavirus, and those whose most important concern about COVID-19 was death (P < 0.05). The results of the present study showed that all participants had social dysfunction. Therefore, health-care providers are suggested to evaluate the psychosocial consequences routinely, design and implement appropriate interventions to deal with these complications. [ABSTRACT FROM AUTHOR]

Background Perfectionism has positive and negative aspects that can have different academic or individual consequences for college students. Objective This study aims to investigate the perfectionism in general medicine interns and the role of demographic factors. Methods This cross-sectional study was conducted on 200 general medicine interns of Guilan University of Medical Sciences in 2021 who were selected using a convenience sampling method and completed a demographic form and the Frost Multidimensional Perfectionism Scale. Independent t-test and MannWhitney U test were used in SPSS v.19 software for data analysis. Results The participation rate was 84.5% (n=169). The maladaptive and adaptive perfectionism mean scores were 62.4±12.2 and 45.1±5.6, respectively. Students aged <25 years had higher scores in subscale of concern over mistakes (P=0.002). Male students had higher scores in parental expectations (P=0.002) and personal standards (P=0.044). Married students scored higher in parental expectations (P=0.031) and parental criticism (P=0.002) and lower scores in personal standards (P=0.002). Students with a history of physical illness had higher scores in personal standards (P=0.006) and lower scores in organization (P=0.045). In married students, more maladaptive perfectionism and less adaptive perfectionism were reported (P=0.018). Conclusion Maladaptive perfectionism of general medicine interns is at moderate level while their adaptive perfectionism is at high level. Young age, gender and marital status affect their perfectionism. [ABSTRACT FROM AUTHOR]

Background Common bile duct (CBD) stone is the most common disorder in the biliary tract, which may lead to hospital admission. Opium addiction is one of the most challenging social and health issues in many societies. An important side effect of opium addiction is the Oddi’s sphincter spasm; i.e., it is likely that the prolonged stasis of bile acid increases the risk of gallstone formation in the CBD. Materials and methods: This cross-sectional study was done from April 2019 to November 2019 in Ghaem Hospital in Mashhad, Iran. 400 patients aged 20-80 years were enrolled. All patients had a definite diagnosis of CBD stones and were candidates for endoscopic retrograde cholangiopancreatography (ERCP). Demographic information of patients, history of underlying diseases, liver laboratory disorders, the existence of concomitant gallbladder stones, and opium addiction information were collected. Results The average age of the patients with opium addiction was 65.12 years, and it was significantly higher than the mean age of the patients (61.41 years) without opium addiction (P=0.01). 74.3% were hospitalized, and 25.3% were outpatients. 35.5% of the patients were men, and 64.5% were women. Our study showed that 41.5% of the patients with CBD stones were opiumaddicted. The average CBD stone size in patients with opium addiction (10.15±4.85 mm) was larger than in patients without opium addiction, but a t test showed that this difference was not significant (P = 0.9). Conclusion In this study of patients with CBD stones referred for ERCP, we observed a high prevalence of opium addiction in patients with CBD stones. [ABSTRACT FROM AUTHOR]

• First study examining fiber intake and metabolic health in Iranian adolescents. • Total dietary fiber was inversely related to odds of metabolically unhealthy status. • Total dietary fiber was inversely related to odds of hyperglycemia. Little is known about the relationship between dietary fiber and metabolic health status in adolescents. This study was performed to investigate total dietary fiber intake and metabolic health status in a sample of Iranian adolescents with overweight/obesity. We hypothesized that higher total dietary fiber intake would reduce odds of metabolically unhealthy status. In this cross-sectional study, 203 adolescents (aged 12–18 years) with overweight/obesity were randomly recruited from several educational areas with different socioeconomic statuses using a multistage cluster sampling approach. Dietary intakes were evaluated by a validated food frequency questionnaire. Demographic, anthropometric, and cardiometabolic data were gathered through standard methods. Adolescents were categorized as having either metabolically healthy overweight/obesity or metabolically unhealthy overweight/obesity (MUO) phenotypes according to the International Diabetes Federation (IDF) and IDF/Homeostasis Model Assessment Insulin Resistance (HOMA-IR) criteria. Subjects had mean age of 13.97 (years) and mean fiber intake of 19.5 (g/d). After considering potential confounders, adolescents with the highest fiber intake, compared with the lowest intake, had decreased odds of MUO based on IDF (odds ratio [OR] = 0.14; 95% confidence interval [CI], 0.04–0.46) and IDF/HOMA-IR (OR = 0.16; 95% CI, 0.04–0.56) definitions. Also, each additional unit of total dietary fiber intake (1 g/d) was associated with lower chance of MUO phenotype considering IDF and IDF/HOMA-IR criteria. Individuals with higher intakes of dietary fiber were also less likely to have hyperglycemia (in fully adjusted model: OR = 0.17; 95% CI, 0.06–0.52). We found that consumption of total dietary fiber was inversely associated with odds of MUO among Iranian adolescents. Further prospective studies are required for confirming our results. The association between dietary fiber intake and likelihood of metabolically unhealthy status was investigated in a sample of adolescents with overweight and obesity. Higher intake of dietary fiber was associated with reduced odds of metabolically unhealthy phenotype based on International Diabetes Federation and International Diabetes Federation/Homeostasis Model Assessment Insulin Resistance criteria. Abbreviation: HDL, high-density lipoprotein. [Display omitted] [ABSTRACT FROM AUTHOR]